The New York 28-Day No-Preauthorization Rule for Inpatient Rehab

What the Rule Says, in Plain Language

Insurers regulated by NY DFS that provide commercial health coverage cannot require preauthorization, and cannot conduct concurrent utilization review, during the first 28 days of an in-network inpatient SUD admission. The LOCADTR tool (Level of Care for Alcohol and Drug Treatment Referral) is required at OASAS-licensed facilities in-state. Cite NY DFS Circular Letter No. 14 (2017), DFS Regulation 218, 11 NYCRR 230.3, and NY AG behavioral health parity guidance. ~350 words.

Which Plans It Applies To

NY-issued fully-insured commercial plans (individual, small group, large group). NOT self-funded ERISA plans (but federal MHPAEA still requires parity). NOT government health programs (different rules apply). Out-of-state insurance follows the issuing state's rules. ~250 words.

What Happens at Day 29

Concurrent review resumes. Insurer's clinical reviewers use LOCADTR (at OASAS-licensed facilities) or similar tools to assess medical necessity. Facility clinical team submits continued-stay documentation. Denials can be appealed internally and externally. ~250 words.

How to Enforce the Rule If an Insurer Violates It

Step 1: Call your insurer's member services and cite NY Insurance Law § 3216(i)(31) / § 3221(l)(7) / § 4303(l). Step 2: File a complaint with NY DFS (1-800-342-3736). Step 3: Contact the CHAMP Helpline (1-888-614-5400) — free advocacy funded by NY OMH/OASAS. Step 4: File with the NY AG Health Care Bureau (1-800-428-9071). ~300 words.

What Else NY Law Protects

No prior authorization for FDA-approved SUD medications on the statewide formulary. Parity between MH/SUD and medical/surgical cost-sharing. Expedited external appeals (72 hours) if delay poses imminent threat. ~250 words.